What Every Two-Year-Old Knows– The Power of “NO”

FayPsych Staff

"The word no must have a place in our lives if we want to live as healthy, happy, mature adults..."

A friend of mine had been experiencing a particularly bumpy few weeks and I invited her to lunch to blow off some steam.  She was troubled by her role as treasurer with a fundraising organization she had belonged to for the past several years.  Squabbles within the group’s leadership over the past few months had come to a head, and she felt torn between wanting to contribute to the group, and her desire to remove herself from the stress and anxiety of being exposed to all the bickering, along with the burden of the job of treasurer itself.

As we talked over a light lunch at our favorite restaurant, she recounted to me the three emails she had already received that morning related to the group’s latest saga.  “I’m
at my wit’s end with this – I have a full-time job I can barely keep up with as
it is.  I just don’t need this drama in my life. ” She said in exasperation.  I think
I’ve finally had it.”  The group’s dysfunctional ways were often the topic of our lunches, so I was not surprised to hear about this latest turn of events.

She was absolutely right. She didn’t need drama in her life. She had a very demanding career, as well as young children and a husband at home who needed her time and attention. As we talked, I reminded her that she had practically been made treasurer at gunpoint two years ago, and that it had not been enjoyable for her at any point since she had begun the job.  She had taken on the position with great reluctance, and it had proven to be as time-consuming and politically charged as she had feared.  She had hoped initially, that the good the fundraising organization did for the community
would outweigh the heavy toll the position took on her.  Over time though, it became clear that was not the case.

“I’m seriously thinking of resigning.” She told me.  “It’s just not worth it.”  She shook her head in frustration.  “I knew I never should have taken on this position.”

She had reached a crossroads, but on a journey that could have been avoided altogether with just one powerful little word – NO.  Had she had the courage two years prior to say no to the nominating committee (and she clearly knew she shouldn’t take the position back then), the stress and anxiety she had experienced over these last
two years could have been completely avoided. She would not have spent hours away from her family and her work, thanklessly trying to please the fundraising committee’s board, had she uttered that one small word– NO.  She knew she should have done it at the time, but she just couldn’t bring herself to say it.

It’s amazing how difficult it is for most adults to utter a simple two letter word.  I think of how often I have witnessed a toddler in a fit of two-year-old zeal throwing around
the word no as effortlessly as they might a toy.  At this stage of development, when a child is discovering his own sense of self and separateness from other people, he
delights in telling other people no as loudly and as often as possible–  especially if things aren’t going his way. He is learning how to establish boundaries and use language to make those boundaries clear.  While adults are reluctant to use the word no, a two-year-old relishes the word.

As we grow older we learn to be much less self-centered than our two-year-old selves, like my friend, who is a very caring and compassionate woman in every way.  This turn toward a more selfless outlook is a natural and necessary part of our development, but it can have a downside.  Our concern for others may make us vulnerable to suffering at tasks or in situations that make us miserable, or do damage to our relationships and sometimes even our health.  As we grow up, shame and guilt also enter our lives and become powerful motivators for our behavior.  We may make decisions based upon our fear that we are “not enough” or are “not living up to expectations.”  We find ourselves saying yes to things we are absolutely clear are not healthy for us, but we feel powerless to conjour up that two-letter word that holds the key to releasing us.

When we become disconnected from the ability to say no, out of misplaced altruism, guilt, shame or fear, we allow others to hold us hostage and use us for their own purposes. We may also wrongly believe that we are acting out of love when we fail
to say no to a parent’s, child’s, spouse’s or other family member’s requests,
when in fact, that failure to say no may be the most un-loving thing we can do,
both for that individual, and ourselves.

It’s easy to slip into the failure to say no trap over and over again;  it happens when we
over-indulge our children by not saying no (teaching them that they can expect to have whatever they want, whenever they want in life),  when we let our own parents
run over us with unreasonable expectations or demands (leaving us to simmer with silent anger at them while we limit our own life choices or our own family suffers from our misplaced loyalties),  when we let a friend coerce us into spending time doing something we don’t want to do (when we know it will make us anxious and cause friction at home), when we let our spouse’s desires overwhelm our own needs time and again (until resentment builds to the point of damaging or destroying our marriage).

The word no must have a place in our lives if we want to live as healthy, happy, mature adults with strong and enduring personal and professional relationships.  Without establishing appropriate boundaries with this powerful tool, we set ourselves up for lives filled with anxiety, depression and other psychological maladies. We also set ourselves up to fail as parents and as romantic partners; we doom ourselves to raise children with unrealistic expectations that the world will never be able to meet, and we assure that we will never give our partners the best of ourselves.   If we truly want to be loving, we must demand the best of ourselves, and for ourselves, and we cannot do so without the power of no in our lives.

My friend and I talked some more over dessert and she decided she would tender her resignation that afternoon.  I could see she was tense about having to talk to the board’s president about her decision. When we said our goodbyes I reassured her that her decision was sound.

I spoke to her the next afternoon and she told me she had officially resigned.  She also said the president had begged her to take another position on the board.  I asked her what she told him.  “No,” she said simply.  I could hear her smile and her relief over
the phone.

Over the next couple of weeks we caught up by phone several times, and the sheer delight she expressed at the free time she now had on her hands along with the stress she was not experiencing was almost contagious.

Copyright © 2011 Fayetteville Psychotherapy Associates, PLC

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How Many Therapy Sessions Will I Need?

William E. Spaine, Psy.D.Dr. Bill Spaine

Understandably, people who are considering initiating psychotherapy want to make plans for the amount of time and money that will be required to achieve their goal for the therapy.  Many potential clients for psychotherapy think of the process in much the same way as they do for visiting a medical doctor, say for a sinus infection or a rash.  In this medical model, the physician does an exam, renders a diagnosis, and prescribes a treatment–sometimes with a follow-up appointment. (Yet even in the medical model, the patient is often referred to a specialist for further testing before a diagnosis and treatment are given.  How disappointing if the referral is to a physical therapist who assigns a discipline of exercise, or how frightening should the referral be to a surgeon!)

Frequently, when I ask a client during an initial appointment what their goal is for therapy, they respond, “I just want to be happy,” as if the adverb “just” suggests that the goal of happiness should not be unreasonably difficult or exceptionally aspirational.   Even if the initially stated goal for therapy is to no longer feel anxious or depressed or to get along better in a committed relationship, honest exploration usually reveals that there are more than just a few factors contributing to the symptoms that have brought the patient to my office.

While psychotherapy does have things in common with medical treatment, it has other qualities that more closely parallel the process of hiring a personal trainer to help guide you in losing weight or accomplishing a physical feat.  For example, if your goal is to lose twenty-five pounds, a personal trainer may work with you in establishing a training schedule which involves regular exercise, a healthy diet, and moderate or no consumption of alcohol. (It would require much more knowledge and discipline to lose twenty-five pounds and keep it off for 10 years!).  If you want to run a 5K, a marathon, or complete a triathalon, your training will be tailored to that particular goal. Careful consideration is given to your current physical shape.  You are very unlikely to achieve your fitness goal if you do not stick to your daily training schedule.  This personal trainer-client model is much like the psychotherapist-patient model; it requires a daily discipline on the part of the patient under the guidance of the therapist, whereas, in the medical model (that most of us are accustomed to), an occasional “check in” with our primary care physician is generally all that is required of us.

A bi-weekly training schedule with a personal trainer and little or no exercise between sessions will result in disappointing progress.  The parallels between reaching a fitness goal with a personal trainer and reaching a psychological goal with a psychotherapist extend further.  In each, you must reach a higher level of competence or accomplishment to understand the true state you were in when you began. You also must work to appreciate what discipline is required of you for progress.
Finally, as you advance in fitness or in psychological growth,  you gain a vision of what potential your life holds as you move toward your goal.

For example: if you begin biking with the goal of improving your cardiovascular condition, you will likely discover that your legs get extremely tired before you achieve what feels like a challenging“aerobic effect.”  That is, your leg strength cannot endure long enough for you to maintain an increased heart rate (accompanied by deep breathing) and feel that you have accomplished a good workout.  However, as you faithfully persevere in your regular biking workouts, your legs become conditioned enough for you to pedal longer, you begin breathing harder, and your heart rate is sustained at an increased level.  You are aware that you are able to push yourself harder and for longer periods and that you are getting into better cardiovascular shape. This brings a sense of accomplishment and self-efficacy, you are delighted with the physical results, and you may even adjust your sights for a higher goal.

A similar phenomenon occurs in psychotherapy: after the initial relief of telling someone what is troubling you and gaining hope that you can survive it, you may be surprised or even somewhat immobilized in subsequent sessions by the force of your emerging fears, shame, hurts, anger, or embarrassment.  You didn’t want all of this; you just wanted to be happy!

Many people terminate therapy at this early stage because the therapy is working!  The awakening to one’s own life, which includes awareness of our feelings, often arouses emotions that we learned “long ago” to avoid or suppress because we feared being overwhelmed and we had no one in our lives to teach us how to regulate those emotions.  As we better learn to regulate affect, we often discover that there was much more “beneath the surface” than we consciously knew, and we can develop the ability to recognize our projections, distortions, minimizations, blaming, and rationalizations.  That is, as you grow stronger, you become more competent in recognizing and addressing psychological dimensions that need attention and further development.  Put
simply, you have to get better to get better. The resulting sense of accomplishment, integrity, self-efficacy, and improvement in your relationships (even at work), may even inspire you to a higher goal than you originally identified.

So, the question “How Many Sessions Do I Need” is answered vastly
differently based on the needs and desires of the person seeking psychotherapy,
and quite frankly, on the expertise of the therapist.  Some patients who have come to me for psychotherapy got what they wanted in one session.  Others have come for many years.  Still others have come for a handful of sessions and returned at a later time for more. The number of sessions from which you would benefit will ultimately be determined by you.  Consultation with your therapist on this topic, of course, is usually the best way to decide, but learning to tune into yourself deeply and to make decisions is often a goal of therapy itself.

Copyright © 2011 William E. Spaine, Psy.D.

Knowledge is the Best Prescription for Antidepressant Success

AntidepressantsFayPsych Staff

Antidepressants are now the second-most-prescribed drug in the United States, to the tune of about $10 billion dollars each year, and more and more Americans are turning to their primary care physicians to prescribe antidepressant medication. According to an article recently published in the journal Health Affairs¹, seven percent of all visits to a primary care doctor now involve the doctor prescribing an antidepressant for the patient during their visit – an increase of 3 percent over 1997 figures.

Since roughly 15 million Americans² are affected by depression each year, it is heartening that so many more of those individuals who are suffering from depression are seeking treatment. But there are dangers to these increases in the prescribing of antidepressants: the glut of advertising aimed at American consumers promising a “quick-fix” for depression has left many people confused about exactly what they can expect from these drugs, when they can expect it, and how these drugs differ from other medications the public is accustomed to taking. This confusion can lead patients who try antidepressants to “give up” on antidepressant therapy when they experience minor side effects or don’t experience immediate relief “like the woman in the t.v. commercial.” It is a terrible thing to see patients who might be greatly benefited by these drugs walk away from them when just a little education could make all the difference.

When properly prescribed and monitored, the right antidepressant can absolutely work wonders to help alleviate the debilitating symptoms of depression for many people. From patients who have struggled for years with chronic depression, to those who are coping with a more isolated bout of clinical depression, many people can benefit significantly from the use of these amazing drugs. When combined with talk therapy, these drugs have been shown to be even more effective and provide even longer-lasting relief from depression symptoms.

However, these medications can, and sometimes do, have side effects that patients should be aware of and that should be monitored. It’s also important for patients to know that it is sometimes necessary to try more than one antidepressant before the “right” one is found to achieve maximum symptom relief and that there is no one-size-fits-all medication that works for everyone. Knowing that there is more to antidepressants than what is portrayed in pharmaceutical company ads is very important in order to get the full benefit of what these drugs have to offer.

Important things you should know about antidepressants:

• When you visit your doctor to discuss an antidepressant prescription, be as open and honest about your depression symptoms (as well as your other health conditions) as possible. The more information your doctor has, the better job he or she can do of matching your symptoms with the right medication. And don’t be afraid to ask questions – the more informed you are about your depression and about the medication your doctor prescribes, the better.

 • ALL drugs, including antidepressants, have side effects. Talk with your doctor and/or pharmacist about possible side effects and drug interactions that might affect you when taking the antidepressant. Most patients find these side effects to be minor and that they go away over time. If you find you experience side effects that are worrisome, contact your doctor for assistance, but again, remember all drugs have side effects.

• Most antidepressant medications TAKE TIME TO BEGIN WORKING. Sometimes it takes weeks before a patient begins feeling any positive effect from the medication and they may be tempted to stop taking the medication because “it’s not doing anything.” If you have not achieved the symptom relief that you and your doctor discussed within the expected timeframe, contact your doctor to talk about your options. There may be other medications that will work better for you, or, your physician may feel a dosage change to your current medication may be appropriate.

 • Each person reacts differently to antidepressant medication. So, if your sister felt better taking Drug X in a week, it does not necessarily guarantee you will react the same way if your doctor prescribes Drug X for you. That doesn’t mean that Drug X may not ultimately work well for you, it means it may just take a little longer to work for you than it did for your sister.

• It is very important that you communicate with your doctor about your symptoms and how you are reacting to your antidepressant medication for the antidepressant treatment to be successful. Just going to your doctor for the initial appointment to get a prescription isn’t enough – you must talk to him or her about any side effects that you experience, or if your depression symptoms are not improving, as well as any other concerns you may have. And don’t give up on your antidepressant without talking to your doctor first. This is the most common mistake we see patients make in regard to antidepressants.

• If you try an antidepressant and it “doesn’t help,” don’t assume antidepressants aren’t right for you. Your doctor may need to work with you to find the right antidepressant for you (there are a number of choices available), or, he or she may need to work with you on adjusting the dosage of your current medication until you achieve better results.

• The combination of talk therapy and antidepressants has been shown to be very effective in treating depression³. Talk with your doctor or psychiatrist about adding talk therapy to your antidepressant therapy for further, longer-lasting symptom relief. Studies4 have also shown that patients treated with talk therapy and antidepressant therapy were more likely to avoid relapse of their symptoms than those who were treated with antidepressants alone. Your doctor or psychiatrist can refer you to a qualified psychotherapist who can help you better understand the issues that are at the root of your depression and help you learn skills and strategies to better cope with the difficulties you encounter in your life.

• Not everyone needs an antidepressant. Just because television commercials have popularized the use of antidepressant drugs doesn’t mean that they are the right choice for everyone. Only you and your doctor can determine if they are an appropriate choice for you. Many patients choose to pursue talk therapy alone to successfully alleviate their depressive symptoms.

We believe strongly that antidepressants are a very beneficial tool for many patients, and our clinic works closely with local physicians and psychiatrists to coordinate the care of patients taking antidepressants. Our goal is to assure that each patient has the most satisfactory outcome possible from the use of antidepressant drugs. Most psychologists and psychotherapists will provide a similar service for their patients – if yours will not do so, find a new therapist that will help coordinate your care, as clinical feedback from your therapist to your physician can be invaluable in identifying the right medication and dosing levels for you.

Antidepressants are by no means a “silver bullet,” but they are powerful tools that have helped many people suffering from depression find relief from their symptoms when used correctly in the hands of patients educated in their use.

¹ Proportion of Antidepressants Prescribed Without A Psychiatric Diagnosis is growing, Health Affairs Vol. 30 No. 8 August 2011

² National Institutes of Mental Health

³ National Institutes of Mental Health, Publication No. 11-3561

4 Interpersonal Psychotherapy for Depression: A Meta-Analysis, Am J Psychiatry, Mar 1, 2011 168: A50

Copyright © 2011 Fayetteville Psychotherapy Associates, PLC